Healthcare Provider Details

I. General information

NPI: 1528691102
Provider Name (Legal Business Name): NORTHWEST FLORIDA HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E WISCONSIN AVE
BONIFAY FL
32425-1809
US

IV. Provider business mailing address

1360 BRICKYARD RD
CHIPLEY FL
32428-6303
US

V. Phone/Fax

Practice location:
  • Phone: 850-547-2209
  • Fax: 850-547-4521
Mailing address:
  • Phone: 850-415-8127
  • Fax: 850-638-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCEY LYNN MORGAN
Title or Position: SENIOR ACCOUNTANT
Credential:
Phone: 850-415-8127